BM BSc Hons MCOptom FRCOphth MBA Consultant VR Surgeon University Hospital Southampton First things first with vitreous loss Stop Keep Calm Ensure patient comfortable and explain it may take a little bit longer ID: 1036305
Download Presentation The PPT/PDF document "Anterior Vitrectomy Stephen Lash" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Anterior VitrectomyStephen Lash BM, BSc (Hons), MCOptom, FRCOphth, MBAConsultant VR SurgeonUniversity Hospital Southampton
2. First things first with vitreous lossStopKeep CalmEnsure patient comfortable and explain it may take a little bit longerGet the kit sortedWait and think!
3. VisualiseSpend time thinking through what you would do and rehearse this over and over again in real time in your head!When it happens it will therefore not be your first time!
4. FlowForget bottle height / aspiration /Vacuum/etc etcUse existing wounds unless they are very leaky and then consider a half width paracentesisGET THE FLOW FORM FRONT TO BACK NOT FROM BACK TO FRONTInfusion in the ACCutter through the hole in PC and down into the vitreous focused right down on the microscopeFluid will now flow backwardsIf the cutter is in the AC fluid will pass into the gel (Hydrate it and stir it up) and gel will move forward into AC and into the cutter.Cutter back and cavitate the central gelGel will fall back with flow
5. CutterFluid on Simcoe or green needle with enough flow rate to keep globe formed. Just into ACCutter into vitreous through the hole in th ePC and as far back as you can focusFoot down. Cut rate usually set and at rates up to several thousand. Eye should remain pressured. If it collapses ease off the foot, increase the fluid flow.Cavitate the gel. It is not a magic wand so avoid waving it around! This pulls on the gel.Keep cutter still, allow gel to come to cutter.When gel stops, slowly rotate and start again until 360 degrees cleared.Cavitate Gel
6. VitreousDifficult to seeConsider a drop of washed IVTA to highlight gelWhen gel cavitated check wounds. If strands they may be free and come out with no traction. If they are attached do not chase in the AC go back through the PCCavitate some moreCheck againCLEAR GEL
7. Cutter cautionEasy to nibble the capsule, back OK but leave anterior intact (?optic capture lens)Easy to nibble the iris (Stay away!)Keep calm, Keep still
8. Lens?If gel cleared I am happy for you to put lens in sulcus (3 piece, change biometry, reduce power 0.5-1.5 (depending on refractive error)Optic capture if possible as very stableMiocholFinal check of wounds ?Suture (depends on wounds!)
9. Post opMaxidex QDS plus (depends how traumatic!)ChloramphenicolPressure?Explain to patient thoroughlyTake responsibility and ensure you follow upWarn about flashes and floaters